乙型肝炎病毒基因型与慢性乙型病毒性肝炎及原发性肝细胞癌病理特点之间的关系

Relationship of hepatitis B virus genotypes with clinicopathological characteristics in patients with chronic hepatitis B and hepatocellular carcinoma

目的:调查乙型肝炎病毒(HBV)不同基因型在慢性乙型病毒性肝炎(CHB)和原发性肝细胞癌(HCC)患者中的分布;分析感染不同基因型HBV导致CHB和HCC的临床实验室结果以及肝脏病理特点之间的差异。方法:随机挑选89例CHB和86例HCC患者,采用实时荧光定量聚合酶链反应(FQ-PCR)结合双色荧光标记的TaqManMGB探针来鉴定HBV基因型。临床实验室检查结果和病理资料摘抄自患者病案。运用统计软件SPSS10.0对结果进行统计学分析,以P<0.05为差异具有统计学意义。结果:本地区,CHB患者以感染HBVB基因型为主,占78.65%,可见B、C混合型,占3.37%;HCC患者以感染C基因型为主,占70.93%;本研究中未见B、C以外其他基因型。B、C基因型在两组患者中的分布有统计学差异(P<0.001)。感染不同基因型HBV的CHB患者间临床实验室和肝脏病理检查指标未显示出明显差异。在HCC患者中,感染C基因型患者较B基因型e抗原阳性率高(P<0.05);感染HBVB基因型和大肝癌发生明显相关(P<0.05);HBV基因型和肿瘤TNM分期、转移和浸润之间均未显示出相关性。结论:本地区CHB患者以感染HBVB基因型为主,C基因型和e抗原阳性是HCC发生的危险因素。针对感染C基因型HBV的患者,积极抗病毒治疗,促进e抗原血清学转换有可能降低HCC的发生率。感染HBVB基因型和大肝癌发生具有相关性,这一结论尚需进一步扩大研究验证。

Objective：To investigate the distribution of different hepatitis B virus（HBV）genotypes in patients with chronic hepatitis B （CHB） and hepatocellular carcinoma （HCC）, and to analyze the clinical laboratory examination outcomes and pathological characteristics of CHB and HCC by infection with different HBV genotypes. Methods： Totally 89 patients with CHB and 86 patients with HCC were randomly chosen for this study. HBV genotypes were determined by real-time fluorescence quantitative polymerase chain reaction （FQ-PCR） combined with double immunofluorescence staining TaqMan MGB probes. The general information and the laboratory and pathological data of patients were obtained by reviewing of the clinical documentation of patients. Statistical software SPSS10.0 was used to for statistical analyses. A P value less than 0.05 was considered statistically significant. Results： HBV B was dominant in the CHB patients in our group, accounting for 78. 650/00 ~ the mixed B and C type accounted for 3. 37%. HCC patients in our group were dominated by C type （70.93%）. There were no other genotypes other than B and C in our group, and there was significant different between their frequency in our group （P〈0. 001）. There were no significant differences in the clinical experimental and pathological parameters in CHB patients with different HBV subtypes. In HCC patients, those with genotype C bad higher positive rate of HBV e antigen than those with genotype B（P〈0.05）. HCC patients infected with HBV genotype B had larger tumor size （P〈0. 05）. No associations were found between HBV genotypes with TNM stage, vascular invasion, or metastasis. Conclusion： Patients with CHB are dominantly infected with genotype B in our group. HBV genotype C and positive HBV e antigen are risk factors of HCC. Antiviral therapy and promoting e antigen seroconversion may reduce the incidence of HCC. HBV genotype B might be associated with larger tumor size.